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If you find yourself having to pee often, planning trips around bathroom access or getting up in the middle of the night to empty your bladder, you may have an overactive bladder (OAB). But depending on your other symptoms, it might be more than OAB. There are a dizzying number of things that can cause you to urinate a lot, from benign causes like drinking too much fluid, to the truly worrisome, like stroke and neurological damage.
“The number of different possibilities is just enormous,” says urologist Heather Wargo, MD, with Lourdes Medical Center of Burlington County. “In order to treat, you have to get at the root cause.”
Do I have an overactive bladder?
First, how many times a day is it normal to urinate? “I was taught that normal was five to eight times a day,” says Dr. Wargo. “But Americans generally drink more now than they did when I was in training, so normal may very well exceed eight.” Wargo says more than eight times a day is still most likely worth looking into.
“When someone comes in and they say they pee all the time, I ask them what they mean by ‘all the time,’” says Wargo. “I have them guess, and then keep a diary.” Wargo says she wants to know how often the person is going, and how much at a time. Going 8 to 12 ounces at a time—a normal bladder volume—for example, will provide a urologist different clues than going 2 to 4 ounces at a time.
“Polyuria means that person would usually urinate normal or large volumes frequently. Overactive bladder refers to someone who urinates frequently with generally small volumes and with urgency,” Wargo says.
Possible causes
Some issues that cause you to pee a lot are benign and easily treatable, while others signal a serious condition. In order to treat, says Wargo, “You have to get at the root cause, or at least break it down between polyuria and overactive bladder. If I give someone a medication to calm down their bladder, but it turns out they’re urinating frequently because their volumes are high, that medicine won’t work.”
Drinking lots of fluid. This is probably the simplest cause. “The more you drink, the more you’ll have to go,” says Wargo.
A mass or obstruction. Bladder cancer can irritate the bladder, obstruct the urethra or thicken the bladder wall and decrease its elasticity. An enlarged prostate can also cause both obstructive and irritating symptoms, resulting in increased frequency of smaller volumes, and thickening the bladder wall and decreasing elasticity. Pelvic masses like tumors or cysts can obstruct or irritate the bladder. And urethral issues can cause incomplete bladder emptying or irritation, resulting in increased frequency.
Diabetes. Excessive urination is one of the hallmarks of diabetes. When you have diabetes mellitus, you have too much sugar in your blood. “If the sugar’s not controlled, the body gets rid of the excess sugar in urine. The sugar drags water along with it so you produce more urine,” says Wargo. That’s why the urine of someone with diabetes often smells sweet. With diabetes insipidus, the kidneys excrete large amounts of dilute urine. There are many causes of diabetes insipidus, ranging from problems in the brain to the kidneys to the placenta to medications, all of which can cause you to pee a lot.
Neurological conditions. A stroke can also cause you to urinate a lot. “There’s feedback between the sensation of fullness in the bladder and control from the brain,” Wargo says. If the stroke happens in a part of the brain that affects bladder control, your brain could tell your bladder to empty too often or cause incontinence. “Often with stroke, there’s initially nonfunctioning of the bladder, and then five to six weeks later the bladder becomes hyperactive,” she adds. Among the other neurological conditions that can affect the bladder include multiple sclerosis, Parkinson's disease, brain tumor and spinal cord injury.
Medications and diet. Some medications can increase urinary frequency. Diuretics signal the kidneys to remove excess salt and water. Both of these will be secreted as urine. Foods such as caffeine, carbonated beverages, alcohol, spicy foods, citrus, sugar, chocolate and artificial sweeteners can also make you urinate more often.
Nighttime urination causes. Wargo calls out two conditions that could cause frequent urination at night specifically: heart failure and sleep apnea. With congestive heart failure, fluid builds up in the tissues, but drains out and becomes urine when you’re lying down (like when you’re sleeping). Sleep apnea, during which your breathing is restricted or you stop breathing when you sleep, can trigger a reaction that signals the kidneys to produce more urine.
Bowel problems. Another cause of urinary frequency is bowel problems. "I always ask about their bowel habits, as this can certainly effect the urinary pattern," Wargo says.
Get checked out
The best way to battle whatever is causing you to pee a lot is to treat the underlying condition. That means you’ll need to visit your primary care provider or a urologist to determine why you’re having symptoms. “We want to make sure there’s no blood in the urine, you don’t have an infection, there’s no excessive sugar and the kidney function’s OK, no mass around the ovaries or uterus,” says Wargo. “It might be as simple as going to your doctor, giving a urine sample and getting lab work.”
